Background: The role of other cardiovascular risk factors (RF) on top of hypertension in worsening arterial elastic properties is still unknown. The aim of the study was to evaluate whether cardiovascular RF can influence aortic and carotid stiffness in essential hypertensive patients.

Methods: 314 hypertensive patients and 110 age- and sex-matched healthy subjects were recruited. Carotid-to-femoral PWV and carotid pulse pressure were obtained by applanation tonometry, and carotid stiffness (CS) by automated system for ultrasound sequence images “Carotid Studio”. Medical history, physical examination, and blood exams were used to identify the following RF: family history of premature cardiovascular disease, smoking, previous cardiovascular events, diabetes mellitus, obesity, hypercholesterolemia, hypertriglyceridemia, low HDL, metabolic syndrome, and chronic renal failure.

Results: Hypertensive patients had higher PWV and CS compared to healthy subjects (9.4 vs 7.4 m/s and 6.9 vs 6.2 m/s, p<0.0001 for both). PWV and CS were classified as “increased” when greater than 90^th percentile, calculated on the healthy subjects sample. Among hypertensives, age- and sex-adjusted multiple logistic regression, including all the above-mentioned RF, demonstrated that only diabetes mellitus (OR 5.4, CL95% 2.6–11.2) and chronic renal failure (OR 7.7, CL95% 2.2–25.6) are independently associated to an increased PWV while only diabetes mellitus is independently associated to an increased CS (OR 3.2, CL95% 1.4–7.1).

Conclusions: In hypertensive population, the additive presence of diabetes mellitus is associated with a further carotid and aortic stiffening, while the presence of chronic renal failure is associated to a further increased PWV. The other cardiovascular RF seem to exert a marginal role, when added to arterial hypertension.